Most bloody ear leaks are related to trauma, but be on the lookout for hemangioma or middle ear cancer. In particular, middle ear cancer is ominous when there is blood in the pus, its pus has a foul odor, or there is severe earache or headache. Suspicious tissue from the external ear canal or middle ear should be taken for pathologic examination to determine the diagnosis and treatment measures. Causes of bloody ear leakage: 1. Allergy Allergy-induced tympanic membrane perforation can cause bright clear or cloudy ear effusion, itching and tearing. 2, Ear polyps Polyps can produce foul-smelling, purulent or blood-like discharge. If it blocks the outer ear canal, it may lead to partial hearing loss. 3, Skull base fracture Ear leakage in skull base fracture can be clear and aqueous, glucose-positive suggesting cerebrospinal fluid (CSF) outflow, and bloody suggesting hemorrhage. Occasionally a retrobulbar hemorrhage is visible on visualization. Ear leakage may be accompanied by hearing loss, nasal leakage of cerebrospinal fluid (CSF) or blood, periorbital bruising (raccoon eyes), and mastoid bruising (Battle’s sign). Cerebral nerve palsy, decreased level of consciousness, and headaches are also common symptoms. 4. Dermatitis of the external auditory canal For contact dermatitis, small vesicles produce a clear, watery ear leak accompanied by edema and erythema of the external auditory canal. Infectious eczema-like dermatitis produces purulent ear leakage accompanied by erythema and crusting of the external auditory canal. Seborrheic dermatitis with greasy ear leakage accompanied by scaling and scaling. There is also significant itching and scaly lesions on the scalp, forehead, and cheeks. 5.Epidural abscess A large amount of creamy ear leakage may be present, accompanied by uniformly throbbing earache, fever, and pain in the temple or ipsilateral temporal top. 6. Mastoiditis This disease produces thick, purulent, yellow ear leakage that is increasing. Its main features include low-grade fever and dull pain and tenderness in the mastoid region. Erythema and edema behind the ear may cause the auricle to bulge; pressure from edema in the mastoid sinus can cause swelling and obstruction of the external auditory canal, leading to conductive hearing loss. 7. Tympanitis (infectious) Acute infectious tympanitis will appear as small, red, bloody blisters in the external auditory canal, tympanic membrane, and occasionally in the middle ear. Spontaneous rupture of these blisters produces ear leakage of serous blood. Other features include severe ear pain, mastoid pressure, rare fever, and hearing loss. Chronic infectious tympanitis causes purulent ear leakage, itching and progressive hearing loss. 8. Otitis externa Acute otitis externa, often referred to as swimmer’s ear, often results in purulent, yellow, sticky, foul-smelling ear leakage. Visual inspection may reveal white-green debris in the external auditory canal. Associated findings include edema, erythema, pain, and itching of the auricle and external auditory canal; severe tenderness to movement of the mastoid, ear screen, mouth, or jaw; swelling and tenderness in the peripheral areas; partial conductive hearing loss; and the patient may also have a low-grade fever and headache on the same side of the affected ear. Chronic otitis externa usually causes a small amount of intermittent ear leakage, which may be plasma or purulent and may be accompanied by a foul odor. Its main symptom is pruritus. Associated manifestations include edema and mild erythema. Life-threatening malignant otitis externa produces debris in the external auditory canal that can get close to the eardrum and cause severe pain, which can occur acutely, especially when treatment is performed on the ear screen or eustachian tube. It is most common in diabetics and immunosuppressed patients. Outbreaks of bacterial infection can also cause itching, tinnitus, and possibly unilateral hearing loss. 9. Otitis media Acute otitis media rupture of the eardrum produces a bloody, purulent ear leakage that can relieve persistent or intermittent ear pain. Typically, conductive hearing loss is exacerbated within a few hours. Patients with acute suppurative otitis media may also exhibit signs and symptoms of upper respiratory tract infection, such as sore throat, cough, runny nose, and headache, as well as other symptoms such as dizziness, fever, nausea, and vomiting. Chronic suppurative otitis media causes intermittent, purulent, foul-smelling ear leakage, usually accompanied by tympanic membrane perforation. Gradual conductive hearing loss and may be accompanied by pain, nausea and vertigo. In this disease, multiple sinus tracts located in the olecranon or external auditory canal may open. This causes a purulent ear leakage. Typical presentation is edema of the auricular canal, erythematous, accompanied by skin thickening. 11, trauma Trauma can cause bloody ear leakage, such as the outer ear hit, foreign objects into the ear, or ear air pressure injury. Usually the bleeding is small or moderate and may be accompanied by partial hearing loss. 12. Tuberculosis Tuberculosis may spread to the middle ear through the upper respiratory tract, resulting in chronic ear infections, thickening and rupture of the tympanic membrane, producing aqueous ear leakage and mild hearing loss. Cervical lymphadenopathy may also occur. 13. Tumor (benign) Benign tumors of the jugular bulb can cause bloody ear leakage. Initially, patients may complain of pulsatile discomfort and tinnitus similar to the sound of their heartbeat. Associated signs and symptoms include progressive dullness in the affected ear, vertigo, conductive hearing loss, and perhaps a red mass behind the eardrum. 14. Tumors (malignant) Squamous cell carcinoma of the outer ear causes purulent ear leakage with tunnel itching, severe irritating ear pain, and loss of hearing. In advanced stages, it may cause facial paralysis. Microhemorrhagic otorrhea occurs earlier in squamous cell carcinoma of the middle ear and is typically associated with hearing loss in the affected area. Advanced stages are characterized by pain and facial paralysis. Wegener’s granulomatosis, a rare, necrotizing granulomatous vasculitis, usually causes perforation of the tympanic membrane and serous ear leakage. Patients may complain of slow progressive hearing loss, cough (possibly hemoptysis), wheezing, shortness of breath, and chest pain. Bleeding skin lesions, nosebleeds and severe sinusitis.